الفهرس 
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Abstract
Egypt has the highest prevalence of hepatitis C in the world, the national prevalence rate of HCV antibody positivity has been estimated to be between 15-20%.
Although the efficacy of antiviral therapy in chronic hepatitis C has improved since pegyaleted interferon/ribavirin therapy was introduced, non response to this therapy remains common.Both virus and hostrelated factors have been reported as factors correlated to therapeutic effects of combination therapy.
It is important to predict the rate of achieving SVR in the individual patient before initiating treatment. Pretreatment predictors of response are useful for advising patients on their likelihood of SVR but absence of favorable factors should not be used to deny therapy.
Our aim was to examine relation between insulin resistance assessed by HOMA-IR, iron overload assessed by serum iron, serum ferritin, total iron binding capacity, hepatic iron grades by Perl’s stain and response to standard therapy.
This study was conducted on 107 patientswith chronic HCV. Their ages ranged from 20-59 years. All patients underwent clinical assessment, hepatitis markers, liver function tests, renal function, thyroid function, quantitative PCR, serum iron, serum ferritin, total iron binding capcity, fasting blood glucose, fasting insulin from which HOMA-IR was calculated, abdominal ultrasound and liver biopsy for grading and staging of chronic hepatitis, prescence or abscence of steatosis and its grades, prescence or absence of iron content and its grades.
Six months after the end of treatment, the patients were categorized into two groups according to their viral load status:
Group (1): patients who achieved SVR. They were 58(54.2%) patients.
Group (2): patients who didn’t achieve SVR (non SVR). They were 49 (45.8%) patients.
Significant relationship was found between SVR and patient sex, age, insulin level, HOMA index, stage of hepatic fibrosis, grade of hepatic steatosis and grade of hepatic iron.
On the other hand, no significant relationship was found between SVR and BMI, ALT, AST level, pretreatment viral load, AFP, serum iron, serum ferritin, TIBC, and grade of hepatic inflammation.
Significant positive relation was found between grade of hepatic iron on one hand and grade of hepatic inflammation, stage of hepatic fibrosis and grade of hepatic steatosis on the other hand.
No significant relation was found between HOMA index on one hand and HCV level by PCR, stage of hepatic fibrosis and hepatic activity index on the other hand.
In a univariate analysis, the predictors of SVR were younger age, lower insulin level, lower HOMA-IR index, lower Metavir stage and lower hepatic steatosis grade.
In conclusion, lower HOMA-IR index is a good predictor of SVR and could be incorporated in assessment of treatment response of pegylated interferon/ ribavirin therapy.This signifies the role of insulin resistance in non response to interferon therapy. Although, iron overload is more related to non SVR, it is not a predictor of response to interferon/ribavirin therapy.